DESCRIPTION (taken directly from the application) Treatment of end stage kidney disease (ESRD) n the U.S. cost about $9 billion in 1994. New information from clinical trials, but initially derived from basic science research, shows that progression to kidney failure can be reduced by 50% in diabetic nephropathy. The possibilities for application of basic science research to impact clinical disease are now better than ever. This is a competitive renewal application for an Institutional National Research Services Award (NRSA) for training in kidney research. In the past five years, while being supported by three NRSA training positions per year, the investigators have successfully trained six individuals in cell and molecular biologic approaches to research problem solving as assessed by their successfully competing for career award funding from NIH or the VA [Veterans Administration] system. Overall, the success could be measured as a rate of 2.5 years of NIH training support required per successful trainee. This is an outstanding record in this time of marked difficulty in obtaining career funding. The investigators have now further developed this basic science training program by improving the recruiting record and by widening the pool of outstanding potential mentors in the basic sciences. The investigators request the same level of support (three positions per year) for this program over the next five years. As a second training option, the investigators have developed a renal epidemiology training program designed to prepare trained individuals in the techniques of cost and outcome research. These individuals will be essential to provide the information needed to make cost-effective decisions regarding allocation of resources in the years ahead. This training program will be based upon the United States Renal Data Service (USRDS), now at The University of Michigan, and led by Drs. Philip Held and Friedrich Port. The work of these investigators has already had an important impact on treatment of ESRD throughout the world. They, together with others based at the School of Public Health, will train a new group of investigators to develop, manage, and ask questions of the large data bases which will form the kernel upon which health policy decision making is based. Overall, support is requested for five trainees per year (three basic science, two epidemiologic) as the investigators strive to meet the future research needs of the Nation.